Order by Fax or Mail

Please send me ________ set(s) of Vehicle Card Pockets. Please Ship: ( ) Surface ( ) Air
Shipping Information
Your Name: **As shown on your credit card.
Company: (optional)
Address:
City:
State/Province/Region:
Zip/Postal Code:			Country:
Telephone Number: (area code + telephone number)		Fax Number:
How did you hear about us?
Email Address: **Please double check email.
Credit Card Information or leave blank if paying by money order - payable in Canadian Dollars to Stroke Communications
Card Type:
Credit Card Number:
Expiry Date (MM/YY):				Security Code:
Date:	Signature:

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